Doctors, patients and the sociology of insulin

Many doctors delay prescribing diabetes drugs or insulin to people with type 2 diabetes for too long according to an international study.

Admittedly, the study was funded by Novo Nordisk, which manufactures insulin and insulin delivery systems, but it does highlight social attitudes to medication including a moral dimension to doctors' prescribing whereby patients need to 'earn' their insulin by making their own efforts to control blood sugar first.

Mark Peyrot, a sociologist at Loyola College in Baltimore, and colleagues surveyed 3,790 doctors and nurses in 13 countries about their attitudes toward insulin and 2,061 patients with type 2 diabetes who were not taking insulin.

Over half - 50% to 55% - of doctors and nurses said they would delay prescribing insulin until 'absolutely necessary.' More than half of the physicians reported 'threatening' their patients with needing insulin if they did not take a more active role in controlling their blood sugar.

'Physicians are often not inclined to tell patients that they need medication, and what we see happening as a result of that is that they often try and emphasize methods that are not as powerful as they could be,' Peyrot told Reuters. 'The issue should be to concentrate on getting the blood glucose down using whatever strategies you need to. Patients should be demanding this of their physicians.'

However, patients often said they would 'blame themselves' if they wound up needing to take insulin, while those who ate better, exercised more and were less distressed about their diabetes were less likely to say they would blame themselves.

Type 2 diabetes is progressive. While diet and exercise can help, Peyrot points out, many patients may eventually need medications, including insulin, to control their blood sugar.